Mental health among teenagers is out of control, there is an epidemic of issues, and things are so much worse than they used to be - that is the message that has been perpetuated in the media and that has largely been bought into in schools.
But the data simply does not support that narrative, according to Tamsin Ford, professor of child and adolescent psychiatry at the University of Exeter.
Professor Ford was one of the principal researchers for the largest study of mental health in 2- to 19-year-olds in the UK, which was published last year and funded by the NHS. It was a follow-up to two previous studies, one in 1999 and one 2004.
“The question we were answering was how many young people in England have a serious impairing mental health condition. This was clinically relevant problems, not mild conditions,” she explains on this week’s Tes Podagogy podcast (see audio player below to listen).
“If we look at the 5- to 15-year-old group, across the three studies, we see a bit of an increase, but not much. It is a matter of a couple of per cent, and the increase is almost all explained by more teenagers having more emotional problems, so significant anxiety and depression.”
The figures for this group were as follows: 9.7 per cent in 1999 and 10.1 per cent in 2004 to 11.2 per cent in 2017.
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Quick read: The essential information of the NHS child and adolescent mental health survey
Want to know more? Professor Ford gives a detailed analysis of the above survey
Mental health in teens
However, in the 2018 study, 16- to 19-year-olds were included for the first time, and Professor Ford says that, in this age group, the statistics are hugely concerning.
“They have very, very high rates, particularly the girls where over a fifth have an emotional disorder and half of those are self-harming.”
These statistics may be puzzling to teachers who see an overwhelmed Child and adolescent mental health services (CAMHS) and much more visibility of mental health problems in schools. But Professor Ford explains that these things are perfectly plausible alongside the data.
“What is without doubt is that referrals to CAMHS have skyrocketed between 2004 and 2018, in some areas by 100 per cent, and lots more young people are presenting with self-harm to accident and emergency, too. So we are seeing an increase in demand for services but that is not necessarily because more young people are struggling in the community. The data does not support that,” she says.
“What I think we are seeing is more people willing to come forwards and saying ‘I need help, I have a problem’. And in the era of austerity, other services that were doing mental health work are pulling back. We have a perfect storm of more people seeking help, and less people available to give that help. We have massively underfunded mental health services.”
Impact on all age groups
Professor Ford stresses that mental health should not be seen as a bigger problem for secondary schools. While mental health challenges get more common as children get older, many of these challenges begin at earlier ages.
“We actually found 1 in 18 2- to 4-year-olds had difficulties that were significant enough to count as a mental health condition,” she reveals.
But what can schools actually do to support young people? What teachers should not be doing is becoming counsellors to fill the void left by support services.
“We need to equip teachers with the means to find out about things from reliable sources, but we do not need to turn teachers into counsellors,” she states. “What they need is structures in schools that can plug them into the support available.”
Does that mean she is against moves to bring mental health services into the school environment - in effect, creating an in-house service?
“I am not sure moving mental health services into schools is the right option: many families and young people will not want their mental health care to take place in the school. Some will, though, of course. I don’t think we should be dictating a model from the top, it needs to be a local and context-dependent model.”
The role of schools
She does think there needs to be more understanding around how school structures and actions schools link with mental health challenges.
“Exclusion from school is very strongly linked to mental health - in both directions. From the 2004 survey, not only were children with a psychiatric disorder more likely to be excluded, but it worked the other way around, if you had just the children doing well, those who were later excluded were more likely to have poor mental health, adjusting for a whole lot of other factors that might have been feeding into that picture.
“I think we should not underestimate the influence of the school, which can be highly positive but also for some children highly negative. It is no doubt very painful for teachers to realise that the structures of the school may not be good for the mental health of pupils.”
High levels of teacher stress
She adds that these structures could also be causing huge mental health challenges in staff: indeed, she has found shocking levels of depression among teachers.
“I have just finished a large trial of a teacher classroom management course. We were measuring teacher mental health all the way through - we found really high rates of depression and stress. Shockingly high rates. That is the second trial to find these results. They were not in the clinical range, but definitely higher than the population norm. I think we need to look after our teacher workforce much better than we do.”
Overall, she says there has to be more urgency in the system to better support young people when they first seek out support.
“We need to think about this properly: if a child is not functioning at their best between the ages of, say, 11 and 16, just think what that does to your life chances? These are really crucial years.
“We have effective treatments, but we just don’t have enough people to deliver them.”
Listen to the full interview
In the podcast, she goes on to discuss the role of social media, peer influence, effective strategies for supporting young people and she gives more detail about the data from the NHS study.
You can listen to the podcast below, or search on your podcast platform for “Tes - the education podcast”
Further reading
